Department of Orthopaedics, Hospital La Paz, Paseo de Castellana 261, 28046 Madrid, Spain.
Clin Orthop Relat Res. 2012 May;470(5):1421-30. doi: 10.1007/s11999-011-2046-0. Epub 2011 Aug 31.
THA is a concern in juvenile idiopathic arthritis (JIA) owing to patients' youth, poor bone stock, and small physical size.
QUESTIONS/PURPOSES: We asked whether (1) uncemented alumina-on-alumina THAs have good clinical and radiographic results at midterm followup in young patients with inflammatory arthritis and end-stage hip disease secondary to JIA, and (2) the anatomic center of rotation of the hip could be reconstructed in patients with acetabular protrusion. We also assessed the rate of surgical complications.
We retrospectively reviewed 31 alumina-on-alumina THAs in 21 patients with a mean age of 30.9 years (range, 14-48 years). Minimum followup until the time of revision of any component or the latest evaluation was 16 months. For nonrevised cases, the minimum followup was 60 months (range, 60-108 months). Acetabular protrusion was mild in 17 hips (Group 1) and moderate-severe in 14 (Group 2). Bone autograft was used to reconstruct the acetabulum in Group 2. Acetabular reconstruction was evaluated according to Ranawat et al.
One cup was revised owing to aseptic loosening at 16 months; the remaining hips showed good clinical and radiographic results. The mean postoperative horizontal distance and the distance between the center of the head of the prosthesis and the true center of the femoral head improved in Group 2. There were no complications related to alumina.
Although THA is a technically demanding procedure in patients with JIA, uncemented alumina-on-alumina THA provides pain relief and improves quality of life. In patients with acetabular protrusion, bone grafts enable anatomic cup positioning. Continued followup will be required to determine whether the alumina-on-alumina bearings in patients with JIA result in less osteolysis and loosening.
Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.
由于患者年轻、骨骼质量差和身体较小，全髋关节置换术 (THA) 是青少年特发性关节炎 (JIA) 的一个关注点。
问题/目的：我们想知道 (1) 在患有炎症性关节炎和 JIA 导致的髋关节终末期疾病的年轻患者中，非骨水泥氧化铝对氧化铝全髋关节置换术在中期随访时是否具有良好的临床和影像学结果，以及 (2) 是否可以在髋臼前突的患者中重建髋关节的旋转解剖中心。我们还评估了手术并发症的发生率。
我们回顾性分析了 21 例患者的 31 例氧化铝对氧化铝全髋关节置换术，患者平均年龄为 30.9 岁（范围，14-48 岁）。任何部件翻修或最近评估的最小随访时间为 16 个月。对于未翻修的病例，最小随访时间为 60 个月（范围，60-108 个月）。髋臼前突轻度 17 髋（第 1 组），中重度 14 髋（第 2 组）。第 2 组使用骨自体移植物重建髋臼。根据 Ranawat 等人的标准评估髋臼重建情况。
1 例髋臼杯在术后 16 个月因无菌性松动而翻修，其余髋臼均显示出良好的临床和影像学结果。第 2 组术后髋关节的水平距离和股骨头假体中心与真股骨头上中心之间的距离均有改善。没有与氧化铝相关的并发症。
尽管全髋关节置换术在 JIA 患者中是一项技术要求较高的手术，但非骨水泥氧化铝对氧化铝全髋关节置换术可缓解疼痛并提高生活质量。在髋臼前突的患者中，骨移植可实现髋臼的解剖定位。需要进一步的随访来确定 JIA 患者的氧化铝对氧化铝关节是否会导致更少的骨溶解和松动。
IV 级，治疗研究。有关证据水平的完整描述，请参见作者指南。
